{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nancy J Pietrulewicz","gend":1,"currentgend":"","add":"11 E SIDE DR","city":"Bucksport","state":"ME","zip":"04416","dob":"1958-05-25","age":"","mstatus":"","insh":"10000051237","cliId":"","pno":2072498621,"cno":"","email":"nancyp2793@gmail.com","ename":"","eno":"","pphy":"PEPPER, CINDY E","ppno":2074697371,"pcpadd":"110 BROADWAY,","pcpcity":"BUCKSPORT","pcpstate":"ME","pcpzip":"44164612","pcpcounty":"","pcpid":"","pcpname":"BUCKSPORT REGIONAL HEALTH CENTER","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"11 E SIDE DR","madd2":"","madd3":"","mcity":"Bucksport","mstate":"ME","mzip":"04416","pcpfaxno":"","pcpnpi":1104867290,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4M11WM2DN29","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E1165","E1142","I10","F325","Z794","Z6833","E039","E785","F258","Z0000","L570","Z124","B349","Z1211","Z1212","K5730","Z6832","R6889","Z1231","Z1151","Z01419","L309","M65331","H2513","E119","C6932","L301","R051","R197","M19041","L858","R030","K589","Z8616","U071","H6123"],"date":["2025-07-15","2024-11-22","2024-11-22","2023-01-11","2023-01-11","2023-07-11","2024-07-16","2024-04-18","2025-09-15","2023-12-28","2025-02-05","2023-12-28","2023-04-04","2023-02-15","2023-02-15","2023-02-15","2023-08-01","2023-09-29","2024-01-25","2023-12-28","2023-12-28","2025-05-20","2023-10-11","2024-12-02","2024-12-02","2023-07-18","2024-06-04","2024-02-23","2024-02-23","2024-11-22","2025-02-05","2023-04-05","2024-02-23","2022-09-29","2022-09-16","2022-09-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","LISINOPRIL","","","Select","Select",""],["","","FLUAD TRIVALENT 2024-2025","","","Select","Select",""],["","","BENZTROPINE MESYLATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","FLUCELVAX QUAD 2022-2023","","","Select","Select",""],["","","ACCU-CHEK AVIVA PLUS","","","Select","Select",""],["","","SULFAMETHOXAZOLE-TRIMETHOPRIM","","","Select","Select",""],["","","ZIPRASIDONE HCL","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","PFIZER COVID BIVAL (12Y UP)EUA","","","Select","Select",""],["","","DEXCOM G7 RECEIVER","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","DEXCOM G7 SENSOR","","","Select","Select",""],["","","FAMOTIDINE","","","Select","Select",""],["","","COMIRNATY 2024-2025","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","NANO PEN NEEDLE","","","Select","Select",""],["","","ACCU-CHEK FASTCLIX LANCET DRUM","","","Select","Select",""],["","","LANTUS SOLOSTAR","","","Select","Select",""],["","","SERTRALINE HCL","","","Select","Select",""],["","","ABRYSVO","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[],"comment":[],"sub":[]}}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}